Chronic Obstructive Pulmonary Disease (COPD) Clinical Trial
Official title:
Health Coaching to Reduce Disparities for Patients With Chronic Obstructive Pulmonary Disease (COPD)
This study examined whether health coaches can improve the management of chronic obstructive pulmonary disease (COPD) in a population of vulnerable patients cared for in 'safety-net' clinics. The study is designed as a randomized controlled trial for patients with moderate to severe COPD. Patients were randomized into a health coaching group and a usual care group. Those in the health coaching group received 9 months of active health coaching. Outcome variables were measured at baseline and after 9 months
Health coaching is a promising model for improving evidence-based care for patients with COPD
which had not been evaluated at the time the current study began in 2014. Health coaching by
health workers or peers trained as coaches, has emerged as an effective model to improve
these management domains for children with asthma and adults with diabetes, and hypertension
receiving care in urban safety-net clinics. The role of the health coach includes many of the
activities also provided by patient navigators, patient educators, and community health
workers. Health coaching is a patient-centered model that recognizes that that people living
with chronic disease are the primary decision-makers in their care; it is a tailored approach
that builds on the strengths and expertise of patients and helps to ensure that they have the
knowledge and skills to be active participants within the medical encounter and to
effectively manage their conditions. Incorporating health coaches into care delivery fits
well with the of integrated care model recommended by the American Thoracic Society which is
based on the Chronic Care Mode. Health coaching can work on several components of the Chronic
Care Model as it applies to COPD to enhance the effectiveness of care delivery and promote
patient goals. Health coaches provide decision support by helping execute customized care
plans jointly developed by patients and providers. Coaches track care targets and conduct
'gap analysis' to identify areas which are sub-optimal. Coaches also help patients to get the
support they need by facilitating access to community, clinic, and specialist support,
improving communication between patients and providers, working with patients to set goals
and develop action plans to reach those goals. The goal of our study was to evaluate the
effectiveness of a health coach model for improving outcomes for low-income urban patients
with COPD. We conducted a randomized trial comparing 9 months of health coaching plus usual
care (health coached arm) to usual care (usual care arm) alone for patients with moderate to
severe COPD cared for at 7 federally qualified health centers (FQHCs). The specific aims of
the study were:
Specific Aim 1. To compare disease specific quality of life for patients randomized to
receive 9 months of health coaching plus usual care to those randomized to usual care alone.
Our hypothesis was that mean quality of life, assessed by the Chronic Respiratory Disease
Questionnaire total score and dyspnea domain score at 9 months, would be greater in patients
in the health-coached arm when tested against the null hypothesis of no difference between
health-coached and usual care patients.
Specific Aim 2. To compare the number of exacerbations of COPD experienced by patients in the
health coached arm to those in the usual care arm during the 9 month period starting at
enrollment. COPD exacerbation was defined as an emergency department visit or hospitalization
for COPD-related diagnosis or the outpatient prescription of oral steroids for COPD-related
diagnosis. Our hypothesis was patients in the health-coached arm would experience fewer
exacerbations when tested against the null hypothesis of no difference between health-coached
and usual care patients.
Specific Aim 3. To compare exercise capacity at 9 months for patients in the health-coached
arm to those in the usual care arm. Our hypothesis was that patients in the health-coached
arm would have greater exercises capacity as measured by the 6-minute Walk Test when tested
against the null hypothesis of no difference between health-coached and usual care patients.
Specific Aim 4. To compare self-efficacy for management of their COPD for health-coached
versus usual care patients at 9 months. Our hypothesis was that mean self-efficacy, as
measured by Stanford Chronic Disease Self-Efficacy Scale would be greater in patients in the
health coached arm when tested against the null hypothesis of no difference in self-efficacy
between health-coached and usual care patients.
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